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Clinical ConnectionsJune 28, 2012

July at MUSC - Time to Increase Situational Awareness!

Dear MUSC Medical Staff,

The start of the academic year in July is always an exciting one. Many medical staff are in new roles. Medical students, residents, and fellows have advanced a year and have different responsibilities. Many attendings are also new, including this summer, where we will have over 100 attendings join MUSC. In addition, it is also the time of year that we have the greatest number of new hospital staff.

Much has been written about the July Effect. The evidence is mixed so it is unclear if a true July Effect exists. If you come done on the side of no July Effect, it is still hard to ignore all the staff in new roles and not come away with some uneasiness regarding patient safety.

Regardless, the natural rebirth and rebuild each July is a great strength for us. This forces us to be more team focused. It also causes us to work hard at eliminating "voltage drops" during patient transitions as well as raise our situational awareness. Situational awareness is a concept from the aviation industry that focuses on knowing what is going on around you during a task so you can anticipate the next step and not be surprised by a particular issue.

If you are not familiar with this patient safety concept, please refer to the following:

With the initial phase of the Epic ambulatory implementation under your belt, we encourage you to take advantage of personalization labs, which are underway. Here you will receive targeted one on one attention specific to your role. Labs are an opportunity to make Epic your own, which was the number one lesson learned from pilot physicians and other go-live participants who are now finding themselves more productive in Epic than they were prior to go-live.

You can self-enroll in a personalization lab in CATTS. Sign in using your NetID and password, then under 'Quick Links', click on 'View' next to 'Self-Enroll – Classes & Events'.

Healthcare associated infections (HAI) affect approximately 750,000 patients a year in the United States resulting in 100,000 deaths, significantly longer stays, and billions of healthcare dollars.

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For decades the Centers for Disease Control and Prevention and the World Health Organization has recommended compliance with Hand Hygiene (HH) during patient care as the most important measure to prevent HAI.

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Traditionally, healthcare providers have had dismal compliance rates (40-50%). To specifically address this issue, MUSC set a facility wide goal to increase and sustain HH compliance at a rate of 90%.

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Since then, there has been a steady significant increase in overall HH compliance and we have maintained this rate over 90% for the past four months.

Care of patients with possible Creutzfeldt-Jakob Disease (CJD) can present significant difficulties that ripple through the organization. The causative agent, a protein agent called a prion, is almost impossible to inactivate. Instruments/equipment utilized for patients suspected of CJD must be quickly identified, sequestered and removed from service until CJD is confirmed or excluded. If CJD is diagnosed, the contaminated, sometimes very expensive, equipment has to be discarded. If not removed from service, the equipment may be used for other patients, placing them at risk for CJD transmission.

To decrease these risks, the following actions are required:

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Notify Infection Prevention and Control staff member on-call when CJD is first considered in the differential diagnosis. Send a text page: Suspected CJD, Pt's. last name and MRN, and your name.

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Enter order for CJD precautions in CPOE.

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Consult ID or Neurology before ordering the 14-3-3 protein test. The lab will not process the test without the necessary consult.

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Avoid invasive procedures until CJD has been ruled out. If a procedure is absolutely necessary, notify IPC staff first.

Risk Management Roundup - What is the role of disclosure after an adverse event?

If your patient ever experiences an adverse event of any kind, Risk Management supports disclosing the event to the patient.

Here are a few tips about disclosing events:

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First take care of the patient; ensure they are receiving the appropriate care after the adverse event.

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Notify the attending, if you are a housestaff and the attending is not yet aware.

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Notify Risk Management, either by reporting online via the "Red phone" on the MUSC intranet or by paging the Risk coordinator on call.

Risk can advise you how to choose the best language, setting, and timing for the disclosure, in order to promote the best experience possible for the patient, and for you.

Heads Up! - Nominate for Physician of the Month!

Know a physician that has gone above and beyond their job expectations? Nominate them for Physician of the Month! The Medical Center's Reward & Recognition Team votes and chooses one top physician each month.

It's easy to nominate!

Go to the MUSC Intranet, click on the "Reward & Recognition" tab at the top right and nominate a physician. Physicians will be recognized with prizes and more!

Employee of the Quarter - Scott Brady, facilitator within the Performance Improvement Department

Scott has consistently demonstrated a strong work ethic and a dedication to success. His efforts have produced high quality results time and time again and significant knowledge and expertise in Lean and Six Sigma has resulted in him receiving numerous positive comments and thank you notes during the quarter. Congratulations to Scott on his well-deserved, departmental award.